Cliff Reid
@cliffreid
Followers
42,116
Following
3,146
Media
1,746
Statuses
13,960
EM/ICM/PHEM doc. LOVE learning + teaching. I work in the sky above Sydney, have the attention span of a bullet, + often have days that are like cartoons #FOAMed
https://cliffreid.substack.com
Joined March 2009
Don't wanna be here?
Send us removal request.
Explore trending content on Musk Viewer
#今月描いた絵を晒そう
• 134260 Tweets
#BUS_แค่ไหนแค่นั้น
• 96402 Tweets
Gabigol
• 73033 Tweets
Rinku
• 54040 Tweets
参騎出陣
• 41859 Tweets
GENE
• 36909 Tweets
大慶直胤
• 34924 Tweets
メンディー
• 34268 Tweets
風呂キャンセル界隈
• 31740 Tweets
#T20WorldCup24
• 31191 Tweets
LILI
• 28146 Tweets
Dube
• 26800 Tweets
Hardik
• 24377 Tweets
ヴィルトゥオーサ
• 23333 Tweets
CokeStudioConcert WithBINI
• 22164 Tweets
Gabriel Barbosa
• 22078 Tweets
Jadeja
• 20615 Tweets
メンさん
• 20062 Tweets
Siraj
• 17570 Tweets
JOSH MOONLIGHT PHOTO
• 15927 Tweets
ノイジー
• 13000 Tweets
#仰天ニュース
• 12681 Tweets
大慶くん
• 11710 Tweets
スクエニ
• 11270 Tweets
ワルプルギス
• 11177 Tweets
Pinned Tweet
I showed a resident how to diagnose a pneumothoraces
She asked 'don't you mean a pneumothorax?'
I replied 'it's pleural'
228
917
10K
Someone left a stethoscope on the orthopaedic surgeon's desk
285
2K
16K
A patient with a rare condition was brought in to our ED last night - the first one our senior nurse has seen in her forty year career.
It was a gunshot wound.
197
676
5K
If anyone knows Kirsty the internal medicine trainee/recent geriatrics clinical fellow from Edinburgh who recently managed an in-flight emergency from Sydney to Hong Kong please tell her she’s awesome & pass on my thanks & Twitter contact so I can give her patient follow up info
19
760
3K
Just a reminder to all nurses and doctors everywhere that placing a hypotensive patient in a head down position isn’t good for their airway, their breathing, their intracranial pressure (and hence their cerebral perfusion) and doesn’t usually help their blood pressure
72
450
3K
I had multiple attempts to insert the arterial line in the correct vessel but all my efforts were in vein
61
170
2K
I am grateful for the Pause our ICU nurse in charge conducted today after the death of a patient.
Apparently the first one done on this Unit.
Meaningful for all staff present.
Interested to hear who else is doing this in their EDs & ICUs
57
302
2K
A beautiful CMAC video. It shows the visual representation of the 'clicks' you feel when the coudé tip of the bougie bounces over the tracheal rings, like a kid dragging a stick along a picket fence.
29
428
2K
Recently on ICU...
Me (to team): this lady no longer requires any critical care. Get her back to the surgical ward asap.
Senior nurse: Cliff I don't know what it is but I'm worried about this patient and don't think she should go to the ward
Me: this patient is staying on ICU.
37
140
2K
The iGel is a great supraglottic airway device
But like other supraglottic airway devices (SAD) it's not foolproof
Here's how to maximise your success with the iGel - a thread 🧵
49
575
2K
How I review ECGs of syncope patients to avoid missing the rare stuff.
The 'WOBBLER' approach
7
357
1K
What are your ‘famous last words’ at work?
I’ll start:
“I’ll just quickly see this elderly patient before I go home”
211
35
1K
Night ED registrar: Sorry to wake you Cliff. I’m in resus with an 11 year old boy who..
Me: Before you go on, are you phoning for advice or would you like me to come in?
Reg: Can you come in?
Me:
34
43
1K
Here's a reflection on how the management style of the emergency physician in charge (EPIC) can mean the difference between life and death
(Long 🧵)
34
358
1K
Hospital design committee sometime in the past
“Let’s get boxes of clinical gloves that open on top, and mount them with that surface vertically. This way, when a clinician pulls out a glove, an additional three will fall on the floor”
“Great idea - motion passed! What’s next?”
35
81
1K
Over the last couple of decades my colleagues and I have analysed HUNDREDS of resuscitation cases and here are the THREE things you need to master to save more lives
10
300
1K
Some maths
Intelligent & experienced doctor
+
Bullying dickhead
=
Bullying dickhead
Colleagues, your professional status & lifelong contribution to medicine does not entitle you to abuse others, no matter how much that short term buzz compensates for your personal inadequacies
11
215
977
Why is it that whenever some dude over 60 goes off to get his prescription for dabigatran or rivaroxaban it always seems come with a free ladder?
22
56
842
Because of modern slang it's hard to know when someone describes an ECG as 'fast AF' whether they're commenting on the rhythm or just a very fast rate
28
69
832
Want to improve your Basic Bag-Valve-Mask Ventilation skills? Here's a VERY short course I made that's free and will only take 5-10 minutes.
11
289
813
When the emergency department becomes the final common dumping ground for the consequences of health and social system failures and lack of alternative services…
… emergency medicine neither contains much emergency nor much medicine
14
168
802
.
@Apple
one thing you could do to help us when we're busy fighting the pandemic is stop iPhones autocorrecting 'Fuck' to 'Duck'. I really don't have the time.
21
115
797
On New Year’s Day at an Emergency Department in Sydney one of my colleagues received a call from the bed manager to say there are no beds so can they please try to send home any patients that don’t need to be admitted
Posting here to spread this ingenious novel practice idea
41
75
788
Please read this thread to better understand how to interpret a high lactate. This patient had a CT to look for mesenteric ischemia because of the high lactate
However they clearly are ALKALEMIC due to HYPERVENTILATION
This is not a lactic acidosis- it’s a LACTIC ALKALOSIS
Age 50 abdominal pain & vomiting. Looks well. No peritonism. How worried are you about ischaemic bowel?
68
67
411
27
162
750
Emergency physician’s pulse:
Seizing child - 56
Surgical airway for GSW to face - 64
Rapid tranquilization of psychotic patient on ice - 68
“Pain everywhere for 3 months” - 104
“Our naturopath said not to immunize our child” - 120
“You know that patient you sent home?” - 180
12
167
743
Local radiologist has opened a takeaway..
“Hi! I ordered a curry”
“You REQUESTED a curry”
22
49
729
Doctors come & go
Resus NURSES are the best potential source of continuity & consistency of how resuscitation is provided in the ED
Invest in them & they become dependable guarantors of quality, safety & excellence
But only if supported & empowered by the medical leadership
8
135
656
We receive almost daily reminders of the fragility and temporality of human life, and yet continue to delude ourselves that we’ll ‘take some time off next year’ or ‘go travelling one day’ or ‘work long hours now to save for retirement’.
Wake up. Live your life. TODAY.
20
284
651
Elevated lactate keeps getting misdiagnosed as 'sepsis' or 'ischaemic gut'
Even by smart people in fancy places
So I'm reposting this video so the resus nurses & residents & medical students can help their senior colleagues think beyond these two causes
8
208
651
Hey anyone around in Britain in the late 70s? Did they ACTUALLY make primary school kids do gym stuff in their vests and underpants or is this a false memory?
611
16
637
Remember that giving peripheral norepinephrine/ noradrenaline, proven in multiple studies to be safe, can cause some intensivists to become necrotic and fall off
25
79
600
Me: 2 packs of diclofenac please
Assistant: you can only have 1
Pharmacist: we’re not allowed to sell 2
Me: it’s not a drug of abuse and an overdose of 2 packs probably wouldn’t harm me
Pharmacist: okay have 2
Assistant(scans box): good news these are 2 for the price of 1 today
25
30
600
1/3 Here’s today’s dose of awesome
Saturday evening visit to the ED by the interventional cardiologist with printouts of before & after angios from the two patients we sent him today so we can relate the pathology to the ECGs and find out how our patients are doing now
16
50
597
Three
#cardiology
cases with diagnostic ECGs in our resus room today and some learning points for emergency clinicians
#ecg
#ekg
16
155
583
Some of my more controversial beliefs about anti-inflammatory drugs are probably best left nsaid
12
37
574
For a sustainable career in emergency medicine, my
#1
tip to emergency medicine trainees is don’t do it full time.
26
46
575
I don’t think supraglottic airway insertion is adequately taught to non-anaesthetists (including paramedics and EM people)
The assumption seems to be that devices like the iGel are foolproof but that’s not the case
I feel a deep dive thread coming on soon
49
28
534
Four ways to get better at sepsis management in the ED and save more lives
- a thread 🧵
6
153
522
Brave RN goes out to 'pacify' the waiting room with an update on waiting times
6
35
501
Everyone training in Surgery, Emergency Medicine and Critical Care please repeat after me:
A normal lactate does NOT rule out ischemic gut
There. Now write it out 100 times
25
55
494
Finally to your relief the night ED registrar arrives and takes a moment to review the waiting list and the state of the department you’re handing over
10
17
490
Remember the old days when it got busy in the ED and you rolled up your sleeves & said ‘Righto chaps let’s smash this queue!’?
Now with thirty 90+ year olds sent from nursing homes with frailty, multimorbidity & polypharmacy & no advanced care plan, the queue smashes YOU
18
31
473
Remember: anyone who is task-focused on a procedure loses situational awareness. Try to be hands-off as team leader otherwise anything could be going on around you.
12
258
470
Major GI bleed
Massive PE
Cardiac tamponade
..all referred to ICU with ‘septic shock’ by normally reasonable ED docs thanks to this EMR alert
... a negative consequence of well-meaning systems design. Nudging clinicians towards a diagnosis of sepsis creates false positives
41
83
469
Quick Free Airway Education!
Taking time to correctly position a patient is, in my view, the NUMBER ONE way to improve your chances of successful airway management
I've made a short (5 min) free lesson
Please have a look and give your feedback after
26
144
457
Called in from home at 0530 by nurse in charge of ED for super sick young patient.
On my arrival (less than 20mins later) team had everything necessary already sorted to stabilise the patient.
It could be argued I made very little difference
Couldn’t be prouder
10
6
459
Never take your EYES off the PRIZE!
During direct laryngoscopy
the assistant should be trained to hand the bougie so the operator doesn't have to look away from the airway
To do so risks losing the view
8
49
446
If you're not a paramedic but you think you know what they do, PLEASE read this
I think everyone in healthcare should read it, but ESPECIALLY emergency medicine and primary care clinicians
1/
17
172
431
I'm sorry, but NO. I've looked this up. There aren’t many case reports but those that exist show that intravenous gasoline causes tissue necrosis, severe lung injury and multi organ failure, often leading to death.
Yep. To quote
@PMHTrauma_ALE
for the 722nd time....
"The only pre-hospital fluid a patient needs is diesel."
In other words, get the patient to the hospital!
16
14
123
28
41
438
This has to be the core mission of the Emergency Physician in Charge, and we should seek neither permission nor forgiveness to discharge this responsibility to the best of our ability
End of 🧵
15
24
434
The surgeon takes a patient with appendicitis to the operating room based on history and clinical exam findings
8
15
426
Just in case anyone still thinks ketamine elevates ICP
“Ketamine was associated with a reduction in ICP….If these findings are reproduced.., ketamine may warrant consideration as a treatment for intracranial hypertension in children with severe TBI”
10
137
427
1/
My favourite three Powerful Magic Words to disarm any clinician from another specialty who for some reason thinks it's okay to yell at your staff:
"Who are you?"
10
39
414
The most dreaded words in emergency medicine:
“You know that patient you saw…”
13
38
406
Patients with acute life threatening pathology often feel the need to open their bowels urgently. Paramedics recognise this as a potentially very important symptom. I call this the ‘Death Dump’ or ‘Pre-terminal Turd’. Probably one of the reasons so many arrests happen in toilets
24
49
411
Age 50 abdominal pain & vomiting. Looks well. No peritonism. How worried are you about ischaemic bowel?
68
67
411
I propose an important new hypothesis on ED human factors paraphysiology, as a non-peer reviewed pre-print. Feel free to cite this Tweet in your academic commentary. This is how science works now post-COVID.
15
88
412
Stopping someone from bleeding to death requires many keys steps
Our team uses this cognitive aid
Page 1 covers general measures to guide vascular access, haemostatic resuscitation, reversal of anticoagulation, and optimising of clotting
1/10
5
162
404
Agitated peri-arrest pt required urgent central access for renal replacement
I asked for ketamine/midazolam but resident held patient’s hand, reassured her & no sedation needed
In the debrief I described him as ‘human ketamine’
Does he realise there is no greater compliment?
11
34
398
1/ Emergency front-of-neck access is not a ‘failed airway’. It’s an alternative airway, and therefore a ‘successful airway’.
Terminology matters, as it frames our mental models, which influence our behaviour.
16
55
395
Last night we had a case that demonstrates an extremely important cause of shock that many ED clinicians know little or nothing about
1/
9
105
385
Always take into account the cultural and linguistic background of your staff when communicating medical orders.
For example we have a nurse from ancient Rome who gave my patient four paracetamol tablets because I prescribed it IV.
13
27
384
Doris' dislocated hip prosthesis went back in easily but we might have overcooked the sedation for a 55kg 90 year old
3
8
390
The European Society of Emergency Medicine has published new recommendations on Emergency
#Airway
Management 🧵
4
100
390
If a trainee has first look at direct laryngoscopy, it's our responsibility to coach them through to first pass success, rather than take over. This is how they learn to troubleshoot, rather than believe some airways are too difficult for them. CMAC is perfect for this.
18
49
387
By all means try a Passive Leg Raise as a ‘fluid challenge’ if you want, but have the head and body flat, not tilted down, and be clear what your end point is
5
52
384
First draft of a PROPOSED pathway for identify 'happy hypoxic'
#COVID19
patients at triage, and giving them a chance NOT to get intubated. Work in progress. Very interested to hear from anyone with something similar/better in place. No experience of these patients yet
23
163
378
The hospital 'wellness program' recommends capitalising on opportunities to breath fresh air outside so you pop out to the ambulance bay and have a moment to yourself
5
14
374
New intern orders the nurse in charge to 'fetch' something for him
6
11
372
I don’t know who needs to hear this but there are other potential sources of sepsis than the chest and urinary tract
33
27
372
Lots to remember to do as a patient tries to bleed to death. Here's the front of our haemorrhage control cognitive aid for use in the resus room.
13
136
368
Doctor Team Leader: “Right everyone let’s have quiet please this patient is sick and we need to focus. I want you to…”
Team: “He’s such a strong leader”
or
Team: “She’s such a bossy bitch”
10
49
368
If your job includes reading ECGs in patients with chest pain, this will be one of the most useful hours you'll ever spend in your career. Trust me on this.
via
@smithECGBlog
Lecture by Smith: Selected Cases of Occlusion MI (OMI), or not, on the ECG
1
150
494
1
85
365
Very short🧵on AF in hospital 1/5
Atrial fibrillation in hospital often starts from interplay between underlying risk factors (substrate) & acute triggers
1
105
357
A recent discussion was around ‘who does the airway belong to in a resus situation?’
I have very strong views on this.
It belongs to the patient.
Your system should be set up so that the patient’s own airway is managed as effectively as possible.
And that takes a team.
9
111
352
Seven hours into the shift you know there’s going to be no time for a meal break so you steal some jelly from the paeds ED fridge
This provides an opportunity to reflect on the shift so far
2
9
352
One of the signs of maturing as an emergency physician is accepting there are situations where more care by me is less useful to the patient than getting them to the right specialist team sooner rather than later.
The best paramedics also go through this.
13
31
353
Even if you remain unconvinced that video laryngoscopy improves your likelihood of first pass intubation success, why would you NOT want to share this view with the rest of your team? Airway is a team sport and the airway assistant and team leader seeing this keeps things chilled
18
37
351
WOBBLER - identify critical ECG abnormalities in the otherwise well looking syncope patient, going in PQRST sequence
3
283
348
Emergency care is broken.
Patients suffer long waits, inadequate warmth, hydration, analgesia, privacy and dignity.
The Emergency Department can't provide all the things patients and other health care workers expect of it.
At some point we need to be honest about that
2
71
341
Before you anaesthetise your next head injured patient, just a quick reminder that ketamine isn’t harmful, but hypotension is
11
39
336
And on today’s edition of ‘Resuscitation - DID YOU KNOW?’
Arterial and central venous catheters are great but they’re not actually treatments. If someone’s critically ill and deteriorating there are higher priority issues that shouldn’t wait for the lines.
Just sayin’
34
36
328
The more I learn about US Healthcare the more impressed I am with the paramedics, nurses, PAs & doctors I know who face that injustice every shift and come back for more. Sisters and brothers I am in awe of your fortitude and am sending a hug of cosmic magnitude in your direction
10
29
318
When NOT to stop resuscitation
Sometimes we stop too early. Sometimes we go on too long. How do we pick the ones we should go the extra mile on? This 6 min excerpt from a talk really comes from the heart
This is the concept that drives everything I do
5
99
322
A naturopath recommended treating abdominal pain by completely covering the belly with herbs but I thought it looked like a total waist of thyme
17
19
325
You tell the medical student there's some great bronchial breathing in bed 10 and he's too shy to mention he forgot his stethoscope...
3
7
322
Any golden rules of leadership that you have learned the hard way either as a leader or someone who is led?
One of my favourites is
“praise publicly, criticise privately”
70
48
323
If there is a cardiac arrest in the operating theatre, who should team lead?
A. Surgeon/proceduralist
B. Anaesthetist
C. Operating theatre nurse
D. EM or ICM physician
E. Don't care but blame Anaesthesia
179
17
318
A schoolteacher tried to shock his class by telling them that he had a glass eye but only one of his pupils reacted
12
21
312
3
255
306